March 3, 2015

Q. Some friends of mine who are lawyers were recently discussing a political corruption prosecution that they seemed to think was a big deal. I believe it involved some sort of campaign finance violations by the campaign manager of someone who ran for Congress a few years back. As a non-lawyer, it wasn’t clear to me what all the fuss was about. After all, people get prosecuted for political corruption all of the time. Are you aware of the case I’m describing, and, if so, what makes it such a big deal?

A. I believe I am. Last month, the Department of Justice announced a political operative named Tyler Harber pleaded guilty to crimes stemming from campaign finance improprieties in the 2012 federal election. The DOJ’s press release said, “This is the first criminal prosecution in the United States based upon the coordination of campaign contributions between political committees.”

OK, fine, but what does that mean?

To understand, it helps to review some background on campaign finance law and the types of committees that raise money for political spending. Candidates in congressional elections typically establish candidate committees to raise funds for their campaigns. The law imposes strict limits on the amount of money a candidate’s committee may receive from a given individual. Currently, for each election an individual may not contribute more than $2,600 to a candidate committee.

Corporations may not contribute at all. The idea is to prevent any single donor from currying undue influence over members of Congress by contributing large amounts of money to help them get elected.

While the Supreme Court allows these limits on contributions to candidate committees, it has struck down other limitations on political spending as violations of the First Amendment’s right to free speech. Notably, the law imposes no limits at all on an individual’s own expenditure of money to advocate the election of a particular candidate, so long as the expenditure is made independently of the candidate and the candidate’s committee. These are known as “independent expenditures.” While there is no limit on how much anyone may spend on an independent expenditure, individuals who make such expenditures must report them and disclose the sources of funds used for the expenditure.

The law also allows the formation of independent-expenditure-only political action committees, which are known as super PACs. There are no limits on the amounts of money super PACs may spend on advocating the election of a candidate or the amounts they may accept from any particular donor. The key, again, is they must not coordinate with a candidate or a candidate’s committee.

As you can see, a lot turns on what counts as “coordination.” According to federal law, a communication is coordinated if it is “made in cooperation, consultation or concert with, or at the request or suggestion of, a candidate, a candidate’s authorized committee or their agents, or a political party committee or its agents.”

Which brings us to the Harber case. In 2012, Harber was the campaign manager for Republican Chris Perkins, who unsuccessfully challenged incumbent Virginia Democratic Rep. Gerald E. Connolly for his congressional seat. According to court documents, during the campaign Harber started a super PAC which, records show, was called National Republican Victory Fund. While serving as campaign manager for Perkins, Harber “made and caused” $325,000 in coordinated expenditure contributions from the super PAC to Perkins’ campaign committee.

After a wealthy donor made the maximum legal contribution to Perkins’ campaign committee, Harber directed the donor to contribute to the National Republican Victory Fund. The donor contributed $300,000, and Harber bought $325,000 in ads opposing Connolly’s re-election. Harber then took steps to cover up his involvement including lying about it to the FBI when the bureau interviewed him while investigating the matter in 2013.

He pleaded guilty to two offenses: making illegal coordinated contributions and making false statements to the government. His sentencing is scheduled for June, and for each offense, he faces up to five years in prison and fines up to $250,000. By pleading guilty and agreeing to cooperate with the government, Harber may of course receive a reduced penalty. But, his case is nevertheless a reminder that coordination is illegal. This may have been the first prosecution for coordination between campaign committees. But, it will not be the last.

C. Simon Davidson is an attorney with the law firm McGuireWoods. Submit questions to cdavidson@mcguirewoods.com. Questions do not create an attorney-client relationship. Readers should not treat his column as legal advice.

Israeli Prime Minister Benjamin Netanyahu addresses a joint meeting of Congress on security threats posed by “radical Islam” and Iran. Congress will reconvene at 10:45 a.m. for Netanyahu’s speech. Full story

When President Barack Obama nominated Loretta Lynch to be the attorney general of the United States last November, he started by listing her exceptional qualifications, from her academic achievements to the cases she tried as U.S. Attorney for the Eastern District of New York – prosecuting terrorists, investigating corruption and vindicating civil rights. He recounted her experiences in the civil rights movement as a little girl in North Carolina, the granddaughter of sharecroppers, perched on her father’s shoulders on the way to his church — experiences that nourished her dedication to the principles of fairness, equality and justice. He also noted that “Loretta might be the only lawyer in American who battles mobsters and drug lords and terrorists, and still has the reputation for being a charming ‘people person.’” The National Women’s Law Center supports her nomination, and the president’s remarks outlined the qualities that compelled us to do so.

Lynch’s hearing before the Senate Judiciary Committee last month confirmed every aspect of the president’s description. During her hours of testimony, she reiterated her fidelity to the rule of law. Her answers demonstrated her exceptional legal expertise, thoughtfulness, and sound judgment. She committed to building relationships with lawmakers and promised to listen to their concerns. Above all, she promised to be a fair and independent voice. In short, she promised to be Loretta Lynch.

Lynch’s background, qualifications, history and personal qualities not only qualify her to serve as the Attorney General of the United States but also suggest her service, once she is confirmed, will be exemplary. Dozens of individuals and organizations submitted letters in support of her nomination and continue to do so (as former New York City police commissioner Ray Kelly and the International Association of Chiefs of Police did just last week). Last Thursday, the Senate Judiciary Committee approved her nomination with bipartisan support. Even the witnesses called by Republicans at the second day of her Judiciary Committee hearing praised her record and reputation and recommended that she should be confirmed.

At long last, more than 100 days after Obama’s announcement, the Senate is finally ready to vote on this outstanding nominee.

This should go without saying, but given that the history of Loretta Lynch’s nomination to date suggests otherwise, I will say it:

Senate leadership should make scheduling a vote on an extraordinary nominee, who would be the first African-American woman to serve as the nation’s foremost law enforcement officer, a priority. And once that vote is scheduled, Senate Republicans should follow the lead of Sens. Orrin G. Hatch of Utah, Lindsey Graham of South Carolina, and Jeff Flake of Arizona, the Republican members of the Senate Judiciary Committee who approved Loretta Lynch’s nomination last week.

Marcia D. Greenberger is co-president of the National Women’s Law Center.

February 27, 2015

It is clear we’re approaching an end game in nuclear negotiations between six world powers — the P5+1 — and Iran. Final negotiating maneuvers have commenced. Secretary of State John Kerry has said there will not be another extension beyond March 31 unless a political framework is in place. Reports from Iran hold that President Hassan Rouhani’s position will be precarious if there is no agreement. And the word from Israel is that the country will use its full strength to prevent any agreement that does not meet its unreasonable demands — including Prime Minister Benjamin Netanyahu’s controversial address to the Congress on May 3.

If there is a negotiated agreement that is rejected, either in Congress or in Iran, it will be clear who bears the responsibility. But if no agreement is reached, it will matter greatly who is seen to be responsible. There is a good argument to be made that it is in the U.S. interest for any breakdown in negotiations to appear to be caused by Iranian intransigence.

How so?

If Iran walks away from the talks, Rouhani can claim to have stood up to “The Great Satan” and protected Iran’s civil nuclear energy program. That may be enough for him Iran’s new president to keep his job, and hold the IRGC and other hardliners at bay, and live to negotiate another day.

If the U.S. is seen as the cause of the negotiations failure, say, because Congress passes a bill requiring a contentious up-or-down vote on the agreement, the results are likely to be very different. Russia and China would surely move to increase commercial, and perhaps military, ties with Tehran. And our European partners, already planning trade ties, might soon follow suit. In short, the carefully constructed international sanctions regime would almost certainly weaken and possibly collapse. Severe strains might well develop within NATO at the same time unity on Ukraine is needed.

This would be even more true if Israeli objections were seen as the root cause, or if Congress was seen as acting on Israel’s behalf. Make no mistake — this issue goes beyond any perceived slight on the part of the Obama administration.Netanyahu’s proposed speech is dangerous.

And then what? In the aftermath of a failed deal, both sides will take a period of reassessment. Iran is unlikely to continue to accede to the current enhanced International Atomic Energy Agency inspections regime, so transparency will suffer immediately. Iran already retains the capability to develop nuclear weapons. In the event of a breakdown in negotiations, Iran’s nuclear program could shift from its current restrained state, to unfettered advancement. Limits on enrichment, centrifuges, and additional research and development would disappear. And without the support of our international partners, Iran would be free to move forward, to build a bomb if it so chooses, without the heavy burden of sanctions on its shoulders.

The path after a rejection of an Iranian nuclear agreement or of a failure to reach one is likely to be difficult, but just how difficult may depend largely on who is seen to have been responsible. The U.S. must hold strong with its negotiating partners, and should, under no circumstances, put itself in a position to have to argue against its own intransigence.

Retired Col. Richard Klass, is a graduate of the U.S. Air Force Academy, the National War College and Oxford University as a Rhodes Scholar. He flew more than 200 combat missions in Vietnam and served in the executive office of the president as a White House fellow. His awards include the Silver Star, Legion of Merit, Distinguished Flying Cross and Purple Heart. He is a member of the Board of the Center for Arms Control and Non-Proliferation.

February 26, 2015

Republican Wisconsin Gov. Scott Walker’s political organization is opening a campaign office for him in Iowa. Ex-Florida Gov. Jeb Bush is meeting with major donors and hosting dozens of fundraisers around the country. Hillary Rodham Clinton, former senator, secretary of State and first lady, is quietly hand-picking a team of high-level advisers to run her anticipated White House bid.

Yet none of these presidential hopefuls has officially declared their candidacy or even announced plans to test the waters of a White House run. That’s given them free rein to raise money through a crazy quilt of campaign-style committees, from tax-exempt issue groups to personal leadership political action committees, unrestricted super PACs, foundations and political organizations. Oversight is scant and disclosure spotty.

With only a couple of exceptions, the nearly 20 hopefuls eyeing the Oval Office are “likely violating” Federal Election Commission regulations that impose strict limits on candidates testing the waters of a White House bid, said Paul Ryan, senior counsel at the Campaign Legal Center and no relation to the congressman. Ryan recently published a white paper dubbed, “’Testing the Waters’ and the Big Lie: How Prospective Presidential Candidates Evade Candidate Contributions While the FEC Looks the Other Way.”

FEC guidelines state clearly that candidates testing the viability of a presidential bid may not collect corporate or union money, and must cap donations at $2,700 per election. Money used to test the presidential waters must also be publicly reported once a candidate officially declares. “They are ignoring federal campaign finance laws,” Ryan said of Walker, Bush and a long list of other candidates.

Until they officially declare their candidacies, the presidential hopefuls in the field run little risk of drawing attention from the FEC, which is stalemated by partisan divisions and has done little to enforce the rules lately. The candidates have said they are complying with campaign finance regulations.

Still, from Bush’s unrestricted super PAC, which reportedly has set out to raise $100 million by March 31, to the nonprofit advocacy group backing Republican Rick Santorum, the former senator from Pennsylvania, the diverse committees operated by this election’s 2016 White House hopefuls raise myriad legal and regulatory questions.

Take the global foundation set up by former President Bill Clinton. The charity’s work fighting AIDS, hunger and poverty has been overshadowed by recent reports it has accepted millions in contributions from corporations and foreign governments. The foundation halted most foreign contributions while Hillary Rodham Clinton served as secretary of State, to avoid the appearance of corruption and conflicts of interest. Should it do the same as she mulls a White House bid?

For all the bad press its foreign contributions have generated, the Clinton Foundation has voluntarily disclosed its contributions. The same cannot be said of the tax-exempt advocacy groups backing such presidential hopefuls as Santorum and former Arkansas Gov. Mike Huckabee, another Republican.

The nonprofit backing Santorum has the same name — Patriot Voices — as his leadership PAC. It was ostensibly set up to advance issues Santorum cares about, but is run by his former aides and largely promotes and publicizes his activities. America Takes Action, a tax-exempt social welfare group, similarly promotes Huckabee’s issues and agenda. Both groups may collect contributions of any size from any source, and operate outside the campaign disclosure rules.

And what about the unrestricted super PAC launched by Bush when he first signaled interest in a presidential campaign? Such PACs may collect unlimited donations as long as they don’t coordinate with the candidates they back. Bush is not yet a declared candidate, which explains why he is reportedly raising money for the group. But in the event Bush announces a candidacy, Ryan argues the PAC should be barred from spending money on his behalf.

As for Walker, his aides told U.S. News & World Report that his political organization, Our American Revival, is promoting “an issue environment and platform” for 2016 candidates, not testing the waters for Walker’s potential presidential bid. The organization, while it does disclose its receipts to the IRS, may accept unlimited contributions from any source.

GOP Sen. Marco Rubio of Florida is on a promotional tour sponsored by Sentinel, the Penguin Books subsidiary that published his book, “American Dreams.” The tour includes stops to sign books in Iowa and New Hampshire — a schedule that might raise questions if Rubio were a declared candidate.

In 2013, the Office of Congressional Ethics asked the full Ethics Committee to investigate whether then-Rep. Michele Bachmann’s book tour, paid for by the publisher of her book “Core of Conviction,” constituted an illegal in-kind contribution to her presidential campaign. The Ethics panel dropped the matter, but Bachmann remains under federal investigation amid various campaign finance allegations.

Only two White House hopefuls — Sen. Lindsey Graham, R-S.C., and former Sen. Jim Webb, D-Va. — have set up legitimate “testing the waters” committees that comply with FEC regulations, Ryan said. Graham’s “Security Through Strength” organization and Webb’s 2016 “Exploratory Committee” both accept contributions no larger than $2,700 per election.

“Sen. Graham and Sen. Webb appear to be complying with that requirement,” Ryan said. “And more than a dozen prospective presidential candidates appear to be ignoring it.”

Eliza Newlin Carney is a senior staff writer covering political money and election law for CQ Roll Call.

President Barack Obama has rightfully been emphasizing the importance of “middle-class economics.” The middle class is the heart of America. But even as the economy picks up as our nation recovers from financial crisis, many hardworking families continue to struggle.

We at the National Patient Advocate Foundation believe any plan to rebuild our nation from “the middle out” must ensure that middle-class families are not subject to crippling medical debt — a problem that force millions of Americans to lose their health coverage, their homes, their good credit standing and their hard-won futures.

Medical emergencies are not predictable, therefore individuals and families are usually not prepared when they occur. Yet, when they strike, they quickly become all-consuming and often financially devastating. Today, more than 1 in 5 Americans under age 65 are having trouble paying medical bills. More than 60 percent of all bankruptcy filings now involve medical debt. And for the first time, the average cost of health care for the typical American family exceeds $22,000 annually.

Unexpected health care costs associated with significant conditions like cancer is putting a strain on middle-income Americans. Therefore, strengthening the middle class — and our nation as a whole — begins with ensuring access to care, while removing the looming shadow of financial hardship.

For nearly two decades our sister organization, the Patient Advocate Foundation, has battled for patient access to much needed care. To date, our case managers have provided direct services and support to more than 750,000 Americans facing chronic, debilitating and life-threatening illnesses. These patients come to us for help with a variety of issues related to their ability to access and afford recommended care. Each patient we help conveys a unique story of hardship and carries a deeply personal burden. When pieced together, these myriad tales — ranging from crippling medical debt to inadequate transportation to coverage denials — paint a startling picture.

Through our work in the trenches, we have a unique perspective on issues that touch the everyday lives of Americans.

In 2014, approximately 60 percent of PAF’s patient cases involved financial distress. This number demonstrates an unsettling theme that when it comes to health care, more often than not, our overall well-being is directly related to the depths of our pockets. Clearly we must do more to ensure affordable care to all. Policy initiatives that establish consumer protections for Americans facing debt, or far worse declaring bankruptcy, as a result of the cost of their medical treatment are an important first step.

Congress can act quickly to assist middle-class patients by passing common-sense legislation that has enjoyed bipartisan support in years past.

Patients who are hit with an unexpected medical bill deserve an opportunity to settle their debt before it has a negative impact on their credit score. The Accuracy in Reporting Medical Debt Act has been introduced in three consecutive Congresses, and would allow patients a 120-day grace period to deal with debt collectors that contact them seeking payment on delinquent medical debt.

Patients who fully pay or settle a medical debt should not have their credit score harmed because of an event they could not control. Introduced in 2013, the Medical Debt Responsibility Act would prohibit a consumer reporting agency from making any report containing information related to a fully paid or settled medical debt, so patients can focus on getting healthy rather than worrying about their ability to secure housing, transportation, or credit.

Patients who are forced into bankruptcy because of medical debt deserve to move through the process as swiftly and painlessly as possible, so they can focus on their health. The Medical Bankruptcy Fairness Act of 2014 would have amended Title 11 of the United States Code to provide protection for medical debt homeowners, restore bankruptcy protections for individuals experiencing economic distress as caregivers to ill or disabled family members, and exempt from means-testing debtors whose financial problems were caused by serious medical problems.

These bills have enjoyed bipartisan support in the past, and would provide tremendous benefit to patients struggling with medical debt.

At some point, we are all patients. Therefore, lawmakers inherently understand the value of patient-centric reform. 2015 is a new year with a new opportunity to further improve our health care system. So let’s finally get back to basics and strengthen our health infrastructure for the people it is meant to serve: patients.

February 25, 2015

A prediction: Within a week, the president will sign an appropriations bill extending funding for the Department of Homeland Security.

Recently, a federal district court judge in Texas doused (but didn’t extinguish) the hottest populist political fire in America by finding the president violated federal procedural rules when the president issued the second of his two executive orders halting the deportation of undocumented persons. The Obama administration declared it would abide by the injunction and vowed to appeal to the 5th Circuit Federal Court of Appeals.

Just prior to the congressional recess, the Senate was unable to debate a House-passed funding bill for DHS because Senate Democrats filibustered the “motion to proceed” over objections to provisions in the House bill vacating the president’s two executive orders on immigration policy.

It is also a setback for the Republican “anti-amnesty” caucus in Congress. The judiciary has the legal issues now, and that’s as it should be.

The “anti-amnesty” caucus ought to release its hostage — funding for programs to combat terrorism within the United States — and let the courts do their job. After all, the primary claim against the legality of President Barack Obama’s executive orders is that he usurped the power of Congress. Only Congress can appropriate; they ought to do their job, not the job of the judiciary.

Interestingly, the judge declared that the president violated the 1946 Administrative Procedure Act, rules which control how the Executive Branch may propose and establish regulations and which established a process for the federal courts to review agency decisions. The judge did not rule on the constitutional issues presented by the plaintiffs, the attorneys general of 26 states.

Will the self-proclaimed “constitutionalists” inside the Congress recognize that this judge’s decision is a victory for their cause, resetting our three co-equal branches of government back within their separate boundaries?

This judge’s decision is also an opening for Senate Majority Leader Mitch McConnell of Kentucky to use a procedural reform initiated by then-Senate Majority Leader Harry Reid, D-Nev., to resolve the current Senate impasse peacefully.

In January of 2013, by a strong vote of 78-16 (with six not voting), the Senate adopted Senate Resolution 15, a rule applied only during the duration of the 113th Congress, to limit filibusters over the motion to proceed in order to allow the Senate to debate and vote upon a bill on its merits. Reid was the author of Senate Resolution 15. McConnell voted for it. Let’s call it “Reid’s rule.”

Today, we are five weeks into the 114th Congress, and Senate Resolution 15 expired in December.

McConnell, a master of Senate procedure, will revive Reid’s rule from two years ago, at least rhetorically, to change the attitude of the current Senate debate over whether to debate funding DHS for the balance of the current fiscal year.

Under Reid’s rule, the minority did not surrender its right to filibuster amendments on a bill or the final Senate passage of a bill; rather, the Senate structured itself to allow four hours of debate on a bill to proceed, with time equally divided, but disallowed the very filibuster battle Reid is waging today.

Will Reid now accept Reid’s rule?

Not incidentally, since the courts now have possession of the legal issues swirling around the president’s executive orders, it is also logical to foresee the current Senate voting to strike the House provisions blocking funding for the president’s executive orders at least as long as the judiciary’s injunction on those orders is in force.

If so, will the House pass the DHS bill without those provisions when it returns? By then, just days from today, the issue will change again.

Will the House shutdown funding for the domestic anti-terrorist agency now that the courts are in charge of the legal issues?

Critics, pundits and average Americans love, even relish, attacking members of Congress for being “in the pocket” of “special interests.” Media coverage is replete with veiled and not so veiled accusations about selling votes for campaign contributions or donations to a member’s “favorite charity.” There have been a few members through the years who have been tagged for such malfeasance.

Enter the phenomenon of a member of Congress shilling for actual constituents. Is that fair or foul? Is it ethical for a like-minded group in one congressional district to bring pressure on a member to vote and conduct their duties in one manner or another? Perhaps not, but what if it is openly on behalf on another nation? One that is decidedly not an ally of the U.S.

Enter Rep. Brad Sherman, D-Calif., for instance. I know Sherman and have for years. He is a fairly anonymous member and a fairly innocuous guy whom my former boss used to lovingly refer to as “the dweeb.” I even interviewed to be his district chief of staff, albeit so long ago, it was like another life. I do remember being a little disconcerted he seemed more interested in my ability to fundraise, rather than my expertise in public affairs or international relations.

Recently, a colleague sent me Sherman’s official and tax-payer funded email newsletter. The congressman’s newsletter began:

Dear Friend, I want to update you on my efforts to strengthen ties between the United States and Armenia. As a senior member of the House Committee on Foreign Affairs, I have focused on recognizing the Armenian Genocide, increasing aid to Armenia, Artsakh, and Javakh, and holding Azerbaijan accountable for its actions.

The headings comprised: Congressional Report on Armenia, Commemorating the 100th Anniversary of the Armenian Genocide, Telephone Town Hall Meeting — Tuesday, April 21, Calling for Permanent Display of Armenian Genocide Orphan Rug In November of 2014, the White House displayed the Armenian Orphan Rug in an exhibit entitled “Thank you to the United States: Three Gifts to Presidents in Gratitude for American Generosity Abroad” at the White House Visitors Center, Aid for Armenia and Artsakh and Holding Azerbaijan Accountable and Increased Assistance to Javakh.

I wasn’t aware that California’s 30th Congressional District was nearly monolithically Armenian and/or of Armenian descent. According to the congressman’s statistics in 2006-2008: White-43 percent, Latino-41.2 percent, African American-3.4 percent, Asian-10.2 percent. And Artsakh? I believe, and so officially does the rest of the world, including the United States, that is the Nagorno-Karabkah region of Azerbaijan that is internationally recognized as illegally occupied by Armenia. As for Javakh, it is a region within Georgia with compact Armenian minority and subject to territorial claims by some more radical Armenians. Actually, many Armenians in Javakheti region of Georgia as it is properly called, carry Russian passports – an eerie and, perhaps not entirely unintentional reminder of Moscow’s recently discovered favorite excuse for invasions.

So why would the Congressman’s newsletter, again at tax payer expense, be devoted exclusively Armenian issues? Why is any member so concerned with a foreign nation that has by anyone’s account, save their own, become a vassal state of the Russian Federation? In fact, Armenia recently turned away from the West by joining Mr. Putin’s Eurasian Customs Union — the counter to the European Union. Armenian borders and airspace are even patrolled by the Russian military. The Armenian president, Serge Sargysan, was recently quoted expressing his warm and fuzzy feelings toward his close ally Iran and the Mullahs. Further, why would a member of U.S. Congress go so far to offend not one, but two of America’s most important regional allies, Azerbaijan and Georgia?

So, really, Armenia is not an important nation to the U.S. Indispensable to the Iranians and Russians? Absolutely. That said, I assume Sherman has a significant Armenian-American community in his district. He should represent their interests — as long as those interests do not go directly against those of our nation as a whole.

This all begs a question I have posed for years: What is the responsibility of a member of Congress? Is it a member’s responsibility to his/her constituents, no matter the allegiances of those constituents? Or do members of Congress have a dual role … one to represent all of their constituents, not just a loud and boisterous and, yes, generous group, but also to represent the best interests of the United States of America?Jason Katz is the principal of TSG, LLC, a consultancy that advises foreign governments, NGOs and corporations in the realms of strategic communications, politics and policy. He is also the former head of Public Affairs and Public Relations for the American Jewish Committee, based in Los Angeles.

Imagine this basic scenario: You are out of milk. You could go to your local convenience store and purchase a gallon for $3. But instead, you drive 25 miles to buy the identical gallon of milk for $5 at a large chain grocery store.

If this sounds absurd, that’s because it is. However it’s analogous to current health care payment policies that allow significantly higher reimbursements for health care services provided in certain settings, when identical, more convenient, and less expensive care in alternative settings exists.

After years of ostensibly trying to reign in unnecessary healthcare spending and maintain Medicare sustainability for future generations, misguided policies on site of service reimbursement have perversely been doing the exact opposite. Medicare continues to pay more for services provided in Hospital Outpatient Departments (HOPDs) ranging from blood work to radiology to chemotherapy administration while other doctors and facilities in the community providing the same services are paid far less. This unfortunate practice for Medicare has increased healthcare costs by billions and simultaneously forced more cost-efficient community providers into hospital settings, which drives costs higher still.

Earlier this month, we were pleased to see President Barack Obama’s FY2016 budget proposal recommend incentives to encourage the delivery of efficient care in the most appropriate ambulatory setting. In his proposal, the President states, “Evidence suggests that in recent years, billing of many ambulatory services has been shifting from physicians’ offices to the usually higher paid hospital outpatient department setting, increasing Medicare spending and beneficiary cost-sharing.”

The White House estimates this reform alone could save $29.5 billion over 10 years.

Under current Medicare policy, for example, a colonoscopy that costs $625 in the office setting is reimbursed more than double that amount – $1,383 – when performed in an HOPD. An MRI scan to diagnose or monitor a patient’s disease progression costs $600 at a community-based imaging facility, but totals $900 or more when conducted by an identical scanner in a hospital radiology suite.

It’s not just Medicare; this problem extends to private insurers as well. The National Institute for Health Reform studied private insurance claims of nearly 600,000 workers and found that increased HOPD spending is leading to overall spending growth among privately and publicly insured individuals because of higher prices charged by hospitals.

Most troubling of all, data reveals that these disparities adversely impact patients. Data from researchers at Milliman show that patients receiving cancer treatments in HOPDs spend $650 more in out-of-pocket copayments compared to patients receiving community-based cancer care.

The negative result of these policies goes beyond the fiscal impact. Particularly in rural areas, many patients are losing access to their trusted healthcare providers due to closure and consolidation of community-based healthcare centers as they are forced to join hospitals. This trend is directly attributable to lower reimbursements for physician-run healthcare practices. Since 2008, 313 independent cancer centers have closed their doors and 544 have entered into contractual relationships with larger hospital centers merely to keep their doors open.

Closures are only one troubling byproduct of payment disparities. Another is the perverse higher reimbursement incentive that encourages hospitals to buy up physician practices in order to increase their profits. They buy the practice, change the name on the door and double the prices. While the hospitals win, everyone else loses. Unfair payment policies have put independent physician practices nationwide in a position in which selling to hospitals is their only option.

The solution is clear — neutralize payments across sites of service. Pay the same fee for the same service regardless of where it is performed. This policy reform has the bipartisan support of lawmakers, the Medicare Payment Advisory Commission and a broad group of health care stakeholders including providers, insurers and consumers.

To advance such reforms in cancer care, Congress should adopt a policy to secure site-neutral payments to keep costs down for seniors fighting cancer, Medicare and taxpayers. Specifically, Congress should create a level playing field in Medicare payments for outpatient cancer-care services. This would preserve patient access to high-quality, cost-effective care in the community setting and help stem the tide of hospital acquisitions of community cancer clinics.

As Obama and bipartisan leaders in Congress call for the delivery of efficient care in the most appropriate setting, we urge them to advance policy changes to establish parity across sites of service in health care. We owe our patients, taxpayers and the nation’s health care system common sense solutions that protect patient choice and reduce costs.

Barry Brooks, M.D., is chairman of the Pharmacy & Therapeutics Committee at The US Oncology Network.

Do you remember Senate Republican Leader Mitch McConnell of Kentucky and House Majority Leader Kevin McCarthy of California promising last fall to return the new Congress to the regular order? The initial test came on the first major bill in the well of both houses, the Keystone XL Pipeline Act. Whereas the Senate produced a veritable gusher of amendments with all hands at the wellhead, the House reverted to a narrowly-constricted flow tube controlled by a few valve masters.

Identical House and Senate pipeline bills were introduced on the opening day of the new Congress by two North Dakota Republicans, Rep. Kevin Cramer and Sen. John Hoeven. Both measures were placed on a fast track to the floor the first week of the session. But that’s where the similarities ended. Full story

Recently, Interior Secretary Sally Jewell traveled to Northwest Alaska to discuss multiple public lands issues, including President Barack Obama’s recent recommendation that Congress protect the Arctic National Wildlife Refuge as wilderness, the highest level of conservation protection possible for America’s public lands. ANWR is one of the most pristine and beautiful places on Earth. The recommended protections ensure this area will continue to provide wild and remarkable recreation opportunities that inspire our businesses and consumers. And while many more Americans will have the opportunity to visit the Grand Canyon or Yosemite, ANWR stands on equal ground with these spectacular, long-protected areas.

Natural resource leaders recognize the wisdom of the administration’s move. Former Deputy Interior Deputy Secretary David Hayes stated, “This is a day many of us have fought for and worked for, and it’s an important step on the road to the more balanced natural resources policy we so desperately need.”

The outdoor recreation economy depends on getting people outside, which in turn means conserving and protecting public lands for activities such as camping, trail sports, snow sports, bicycling, water sports, hunting, fishing and wildlife viewing. Each year, the outdoor industry supports more than 6 million American jobs, generates $646 billion in direct consumer spending and contributes $80 billion in federal, state and local taxes. In Alaska, outdoor recreation generates $9.5 billion in consumer spending, supports 92,000 jobs and generates $711 million in state and local tax revenue.

Over the past several years, I have taken more than 24 industry executives on trips north of the Brooks Range and into ANWR. We have rafted wild rivers, fished for Arctic char and seen polar bears, brown bears, wolves and musk ox. We have watched the wildlife spectacle of thousands of caribou moving past our camps as they migrate to their calving grounds on the coastal plain. Without exception, each one of us regarded the trip as a life-changing experience and has devoted time and resources to protecting recreation assets like this one for our grandchildren.

As business leaders, the health of our industry depends on land and water that are protected for people to enjoy America’s beautiful natural landscapes, pursue healthy and active lifestyles and use our products to have the best experience possible. The president’s proposal meets those goals.

This is the first wilderness protection any president has recommended to Congress for a refuge since 1974. Besides providing home to polar bears, caribou and birds that migrate from six continents, the Arctic Refuge is home to and provides sustenance for the Gwich’in people. By offering protection of this ecosystem and tourism destination, Obama and Jewell have done the right thing, and I thank them. Preservation of ANWR is far more than a conservation legacy opportunity, it is a gift to all Americans for generations to come.

February 23, 2015

Cybercrime is metastacizing. Hackers stole 900 million financial and personal records in 2014 alone, and hacking now costs consumers and companies $375-575 billion annually. That’s putting pressure on both parties to act, but Congress hasn’t yet been able to pass a cybersecurity bill. President Barack Obama’s proposal to require businesses to share information on hacking threats with the Department of Homeland Security has raised both political and privacy issues, and drawn opposition from conservatives, business and the American Civil Liberties Union.

But even if such a bill passed, information sharing would not have stopped high-profile cyberattacks on Anthem, Sony Pictures, Target, Home Depot, banks in 30 countries including JP Morgan Chase, or others. The glaring cybersecurity problem today is our password practices, which have become dysfunctional. Most security breaches involve weak or stolen login credentials.

Passwords are a weakness for Congress’ own cybersecurity, too. According to Rep. Jim Langevin, D-R.I., co-chairman of the Congressional Cybersecurity Caucus, the number of daily cyberattacks on congressional networks is “huge.” Congressional staff computers have sophisticated firewalls, but even the best technologies can’t protect them against bad practices of humans, such as password reuse and sharing. Recently, the House started requiring regular password changes and instituted mandatory information security training for any staffer with a House network user name and password.

Some, such as bank and insurance regulator Benjamin Lawsky, superintendent of the New York State Department of Financial Services, propose scrapping the password system altogether. But there is a way to fix it.

Passwords originated half a century ago, when a few research institutions had one precious computer, and the few people who had access to it needed just one keyword to remember. Today, hundreds of millions of us have dozens of accounts each. In an effort to make billions of passwords distinct and safer from hackers, we’re making them more and more complex and less and less memorable.

The less memorable passwords are, the less secure they are. Continually resetting passwords we can’t remember makes us more vulnerable. So does storing them on a computer or in a drawer. One place they are safe from hackers is stored in your brain, provided you can get them out when you need them.

My field of memory research has learned much about how humans encode, store and retrieve information committed to memory. It has evolved excellent computer simulation models that predict how likely a person is to recall information, and can help select words that are optimal for later recall by specific people.

That’s useful for data security engineers, and I’m now collaborating with one to build a new password system. It draws on decades of lab research on optimizing human memory, much of it funded by federal agencies such as the National Science Foundation. The new system will have the ubiquitous “password strength” meter, but also a “memorability” meter. It will generate memorable combinations of words that are personally relevant and meaningful for users, but appear random to anyone else, making them memorable and much harder to steal.

Besides passwords, there are other intractable cybersecurity problems that scientists who study human psychology and behavior can help solve. For example, spam/phishing filters mechanically search for suspicious individual key words, but not for typical spam narratives, so spam slips the net and lands in your inbox. Algorithms designed to resolve disputes between online buyers and sellers can’t distinguish between “liar buyers” with a bogus complaint and truthful ones with a legitimate complaint. Applying models from linguistics, memory and cognitive science, and teaching computers how to comprehend patterns of meaning rather than just pick out words or numbers, can help make these structures smarter and more secure.

This field of teaching computers to think more like humans is called cognitive computing. It has been incubating for about a decade now, and is likely to generate big breakthroughs that we’ll all be using before long, including better passwords, and many new ways to find meaning in the torrent of digital data rapidly headed our way.

Lab research into human cognition is directly enabling advances in cognitive computing, which can help stem the rising tide of cybercrime, and help make the benefits of the Big Data revolution available and meaningful for everyone. That makes it a smart investment for taxpayers. Whether or not Congress can pass an information-sharing bill, if it wants to do something effective about cybersecurity, it can fund this research.

Washington will soon be abuzz with debates over honeybees. President Barack Obama has commissioned a “pollinator task force,” and a federal honeybees strategy is expected any day now. Meanwhile, the Environmental Protection Agency appears to be preparing its own regulations to “protect” bees.

Farm state representatives need to follow this closely, or they could find their constituents getting steamrolled by junk science. To please an increasingly noisy band of loyal activists, the White House has positioned itself to bypass congressional committees that have jurisdiction over these issues, and impose sweeping pesticide restrictions that ignore potential damages to farmers, consumers — and honeybees. Full story

February 19, 2015

Despite the new “ceasefire,” current diplomatic approaches to deterring Russian aggression in Ukraine are a failure. While sanctions are destroying the Russian economy, they are not stopping the Kremlin from supporting rebels, deploying troops along Ukraine’s border or exercising their strategic nuclear force posture. Vladimir Putin prefers playing chess to the popular American board game Monopoly. His inner circle is interested in re-establishing a sphere of influence and a strategic buffer. They are betting that by the time Western sanctions “work,” Ukraine will be a failed state in the Russian orbit and NATO a hollow alliance.

Re-establishing security in Europe requires a bold new plan: accelerating NATO force modernization initiatives in Eastern Europe and immediately delivering its surplus Cold War equipment to Ukraine. The plan is simple and sends a clear signal. NATO member states back Ukrainian independence and have the military capabilities to deter future conventional conflict. The plan requires Congressional committee action. The next National Defense Authorization Act should include language that fast tracks foreign military sales for Eastern European members of NATO. These countries need firm guarantees the United States is committed to NATO and willing to replenish weapons stockpiles they send to defend Ukrainian sovereignty.

There is historical precedent for using NATO equipment to resupply an ally in the middle of a conflict. During the 1973 Yom Kippur War, the United States military launched Operation Nickel Grass, airlifting more than 22,000 tons of military equipment, including stockpiles from depots in Europe, to Israel. The move was not without risk, leaving NATO conventional defenses significantly weakened in the event of a crisis with the Warsaw Pact. Yet, decision makers at the time correctly calculated that the Soviet’s would not capitalize on the situation before America replenished the stockpiles.

In the current crisis, the United States will again have to play a leadership role, using is edge in military logistics to help deliver the equipment to Kiev while fast tracking foreign military sales required to replace Soviet era weapons. The Ukrainian Freedom Support Act authorizes the U.S. president to address Ukraine’s persistent requests for weapon, highlighting the need for anti-tank weapons, drones and radar systems. Congress can build on this act with an expanded initiative that helps NATO partners replace Soviet era equipment with more up to date American systems.

Through Armed Services Committee hearings in the lead up to the National Defense Authorization, Congress can require the secretaries of State and Defense to assess the state of NATO forces with an eye towards sending old systems to Ukraine, as well as require testimony on actions taken to support overall NATO force modernization plans. Both moves send a clear signal to the White House: take NATO and the Ukrainian Freedom Support Act seriously.

This plan provides Ukrainians weapons they know how to use, as opposed to training them on new systems they are unfamiliar with operating or sustaining. Many Eastern European NATO members still have large stockpiles of Soviet weapons that could be a force multiplier in the Ukrainian conflict. This includes large inventories of anti-tank weapons, artillery systems and even combat aircraft — all platforms the Ukrainians desperately need to hold the line against further Russian advances. Poland has more than 2,000 RPG-7 anti-tank systems and 1,000 SWD Sniper rifles that match current Ukrainian requests. They also have surplus T-72 tanks. Bulgaria has more than 80 combat jets and helicopters it is looking to replace.

Second, the plan offers the United States a cost-effective path for accelerating force modernization plans in Eastern European NATO members. It reassures allies and is consistent with NATO’s 2014 Wales Declaration to bolster alliance defense capabilities. The plan complements efforts to deter Russian including the recent announcement that six new bases will be set up alongside a 5,000-strong “spearhead” reaction force.

Signaling a willingness to uphold the current international order and reassuring key allies has benefits that reach beyond Europe. Reading Ukraine as simply a European security issue is a deeply flawed exercise. U.S. allies are watching. A failure to support a country under attack by a mix of proxy supported rebels and top-tier Russian military without uniforms shows the U.S. is unwilling to defend the territorial integrity of states. With one move, the United States can check Russian advances in Ukraine and reassure its allies. In the short-term Ukraine receives the military assistance it desperately needs. Over the long-term, a modernized military in NATO front-line states offers an expanded conventional deterrent to future Russian aggression.

Benjamin Jensen, Ph.D. is a scholar-in-residence at American University’s School of International Service and runs the Advanced Studies Program for the USMC Command and Staff College.